One in five lucrative bonuses paid to senior doctors went to a woman last year, prompting concerns that an "old boys' club" awards system is contributing to a gender pay gap in the NHS.

Sky News analysis of Clinical Excellence Awards (CEAs) paid to consultants in England and Wales in 2017 reveals that 20% of 318 awards worth more than £14m in total went to female applicants.

The figure was down 2% on 2016.

Analysis of the most valuable awards made over four years, from 2014 to 2017, shows that on average, women received only 20.5% of the bonuses.

The figures also show that the higher the value of the award, the less likely it was to be received by a woman.

Image:Many NHS professionals are concerned about the rewards system

A Sky News freedom of information request to hospital trusts in England found that women were more likely to receive lower-value CEAs, with around 30% receiving payments.

That still falls below the proportion of female consultants in the NHS, around 33%, and both the Department of Health (DoH) and doctors' union the British Medical Association (BMA) accept that women are underrepresented in the system.

CEAs are divided into 12 levels, ranging from £3,000 to just over £77,000, and are given to consultants who demonstrate they have contributed to improvements in patient care by working "over and above" their normal clinical or academic role.

Once awarded, they are paid annually for at least five years and the payments are pensionable.

Image:A senior hospital trust executive described it as 'an old boys' club that should be scrapped'

Levels one through to eight range from £3,016 to £30,160, and are awarded by local hospital trusts, while levels nine to 12 - known as bronze, silver, gold and platinum and worth between £36,192 and £77,320 - are awarded by a national panel appointed by the DoH.

The figures show women who apply are almost as likely as men to be successful, with around 25% of male and female candidates receiving awards.

However, in the three years from 2014-2016, some 813 women applied for CEAs - compared with 3,124 men.

Senior female doctors and NHS executives say women are not encouraged to apply and that the system does not take account of the different career paths and challenges facing women.

Image:The system is likely to be reviewed as part of negotiations over new consultant contracts

Because the awards are incremental and applications are annual, any women taking a career pause to have children, or working part-time and therefore less able to take on extra responsibilities, is at a disadvantage.

Sky News has spoken to a range of female consultants, NHS executives and specialist professionals who raised misgivings about the system, though few were willing to speak on-camera for fear of damaging their prospects in future.

"It’s an iniquitous, subjective system that rewards those in managerial posts, while the rest of us take care of the daily clinical work," one experienced female consultant told us.

A senior hospital trust executive described it as "an old boys' club that should be scrapped," while a lawyer with extensive experience of consultant contract negotiation said the system was "a legal challenge waiting to happen".

Image:About a third of consultants in the NHS are women

Jane Dacre, president of the Royal College of Physicians and one of the most senior female doctors in the NHS, said: "It does not seem right to me that only 20% of awards are given to women and it is not right that the higher up the food chain you go, the less likely women are to get them. We can explain some of it away, but not all of it."

Sally Davies, until last year the president of the Women’s Medicine Federation, told Sky News the system was a relic of a time when medicine was male dominated.

"It was designed when it was mainly men in the system looking after other men," she said.

"It makes you question whether women in medicine are valued. They are the ones in the NHS running the system, ie they are too busy with patient care, raising standards, (rather) than actually sitting down and applying for an award.

"It also makes you ask, are they being encouraged? Is somebody tapping them on the shoulder at their annual appraisal or something and saying, 'this is wonderful work, you should put in for an award'?"

The BMA and the DoH declined requests for interview, but the CEA system is likely to be reviewed as part of negotiations over new consultant contracts.

Image:Female doctors say women are not encouraged to apply for the awards

The BMA has already threatened legal action if the Government attempts to remove them from any new deal.

A spokesperson for the BMA said: “Clearly more needs to be done to make them [CEAs] both fair and representative at a local and national level.

"Through recent contract negotiations the BMA has proposed improvements to the CEA system to ensure the process is open and transparent, but the culture around recognition needs to improve so that more women feel empowered to apply."

The DoH said women were as likely to be as successful if they applied, but accepted they were under-represented in the number of applications.

"We are working to reform local CEAs as part of the wider consultant contract negotiations – in the meantime we expect employers to run a fair, open and transparent awards scheme," said a spokesperson.

NHS Scotland and the NHS in Northern Ireland do not have comparable schemes.